Planning, Implementing, and Evaluating Your Health Promotion Programs

A 6-Week Public Health Course

Week 2: Assessing Our Population, Part 1

Today:

•Discuss behavior change theory application homework

•PRECEDE-PROCEED introduction•Assessing our Population Part 1:

epidemiological assessment and behavioral and environmental assessment

•Applying Social Cognitive Theory

Homework

•What did you learn?•Which theory did you think was best for

STI prevention?•Share components of the best fit theory

Health Belief ModelConstruct Application

Perceived susceptibility

• Use guest speakers who are close to students’ age• Famous people with HIV (posters/videos)• When students think they have an STI/nervous about test results, make it real that they could have an STI

Perceived severity • Graphic pics of STIs (health fair, posters in wellness)• Reality of HIV (side effects and cost of meds)• Infertility (may not be salient for many adolescents)• STIs make more susceptible to HIV (newsletter article, educate students during wellness class, in wellness center)• How do you deal with students who have had an STI many times and don’t seem to care?

Perceived benefits • Avoid stigma of STI (individual or group counseling)• Preserve fertility (might not be salient to adolescents)• Pregnancy prevention/better future (groups of females)

Health Belief ModelConstruct Application

Perceived barriers • Educate students in groups/couples (make using a condom less awkward and stigmatized)• Make sure students have access to free condoms when they need them, including the weekend (expensive)• Female empowerment/Male responsibility (females apprehensive to confront males about condom use/feminine/masculine roles)• Have condoms available in dorms/bathrooms, etc. (privacy and access)•Have a number for students to call or an anonymous question box (embarrassment)• Talk about effects of drinking/drugs on decision making/troubleshoot (bad decisions when under the influence) • Discuss myths about STIs (break down any imagined barriers)

Health Belief ModelConstruct Application

Cues to action • Reinforce condom availability• Encourage all students to make an appointment for STI testing if they have symptoms• Peer mentors• Brochures/handouts• Social networking

Self efficacy • Teach students proper condom usage (banana)• Trouble shoot difficult situations• Help a student talk with her partner before they are in the heat of the moment• Ask question and don’t be judgmental • Mentor students in developing self respect and increased self esteem • Review student understanding of information• Encourage students to ask questions

In Sexuality Education

•Works with:▫Primary prevention—prevent pregnancy,

STIs, etc. by increasing condom use▫Secondary prevention—increase early

detection of STIs or HIV to reduce spread/early treatment

•Does not work well with:▫Comprehensive sexuality education

programs that are not action oriented▫Not a good fit for abstinence only (threat

logic)Source: Resource Center for Adolescent Pregnancy Prevention. http://www.etr.org/recapp/index.cfm?fuseaction=pages.TopicsInBriefDetail&PageID=51

JC’s No Sex Policy

•What is the effect on STI rates? When would it be helpful and when harmful?

•What is the effect of abstinence-only education?▫Lowest STI rate in 15-24 y/o from states

with no mandates for abstinence education▫States with mandates emphasizing

abstinence had the highest rates▫States with mandates to cover (not

emphasize) abstinence fell in the middleSource: Hogben, M. et al. (2010). Sexuality education policies and sexually transmitted disease rates in the USA. International Journal of STD and AIDS. 21; 293-297.

In Sexuality Education

•Works with:▫Programs designed for long term behavior

change▫Overall effective▫Couples and individuals

•Does not work well without:▫Integration with the other theories

El-Bassel, N, et al. (2003). The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. 93(6), 963-969.DiClemente, R.J., et al. (2007). A review of STD/HIV prevention interventions for adolescents: sustaining effects using an ecological approach. Journal of Pediatric Psychology. 32(3), 888-906.

In Sexuality Education

•Works with:▫Working 1:1 with teens▫Troubleshooting risky behaviors▫Interventions that take place in the HW

center•Does not work well with:

▫Comprehensive sexuality education programs that are not action oriented/cognitive learning-based programs

▫GroupsSource: Resource Center for Adolescent Pregnancy Prevention. http://www.etr.org/recapp/index.cfm?fuseaction=pages.TopicsInBriefDetail&PageID=51

In Sexuality Education• Works with:

▫Prevention-based programs (prevent sexual involvement or increase condom use)

▫Particularly good for pregnancy prevention, STI prevention and HIV prevention Influenced by

knowledge/skills/attitudes/relationships/environment, few positive role models for teens, behavioral skills practice

• Does not work well with:▫Comprehensive sexuality education programs that

are not action oriented/cognitive learning-based programsSource: Resource Center for Adolescent Pregnancy Prevention. http://www.etr.org/recapp/index.cfm?

fuseaction=pages.TopicsInBriefDetail&PageID=51

Cool Things That Came Up• Age-specific interventions• A lot of partnerships• Myths: “One male student told me that if he put

his finger in his partner’s vagina then touched his finger behind his ear and it did not burn, then she didn’t have an STI.”

• Strategic placement of condoms• Role play situations• Peer education/groups• Cultural/gender-specific interventions• Know the policy to advocate for change

Social Assessment

•What health issues affect students’ quality of life?

•Involving the student in planning

•Key informant interviews•Focus groups•Observation•Surveys

Epidemiological Assessment

•Documents which health problemsare most important

•Data collection•Data analysis

•Do you want to focus on a specific group?•How about a specific disease?

Behavioral and Environmental Assessment

“The Behavioral and Environmental Assessment identifies factors, both internal and external to the individual, that affect the health problem.”

Questions to Ask•Behavioral factors

▫What are the behaviors linked to this issue?▫Which of these behaviors are most important?▫Which of these behaviors are most changeable?

•Environmental factors▫What parts of the environment (social and built)

hinder healthy choices?▫Which of these factors are most important?▫Which of these factors are most changeable?

Finding Information

•Interviews, survey, focus group•Literature

▫PubMed (http://www.ncbi.nlm.nih.gov/pubmed)

▫Google scholar (http://scholar.google.com) ▫Hint: American Academy of Pediatrics:

Condom Use by Adolescents: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/6/1463 (check out the PubMed and Google Scholar links on the side too)

Organize Your ThoughtsMore important/more

changeable 

(focus on these)

Less important/more changeable

(only if you need to demonstrate for political

purposes)

More important/less changeable

(do these second/good for innovation)

Less important/less changeable

(don’t worry about these)

ExampleMore important/more

changeable 

-Access to healthy food-Access to recreation

-Portion sizes

Less important/more changeable

-Calorie counts are not posted in the cafeteria

More important/less changeable

-Preference for unhealthy foods

-Unhealthy eating part of students’ culture

-Genetic predisposition to gaining weight

Less important/less changeable

-Delivery restaurants don’t offer calorie counts

-Students go home on weekends and do not eat in

the cafeteria

Social Cognitive Theory

Closing

•Homework #2 due by COB on Friday•Questions?